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image/svg+xml Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao Closed Access logo, derived from PLoS Open Access logo. This version with transparent background. http://commons.wikimedia.org/wiki/File:Closed_Access_logo_transparent.svg Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao Heart Rhythmarrow_drop_down
image/svg+xml Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao Closed Access logo, derived from PLoS Open Access logo. This version with transparent background. http://commons.wikimedia.org/wiki/File:Closed_Access_logo_transparent.svg Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao
Heart Rhythm
Article . 2013 . Peer-reviewed
License: Elsevier TDM
Data sources: Crossref
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Failure of a spliced DF-4 ICD lead

Authors: Romain, Cassagneau; Mikael, Hanninen; Vincent, Ganiere; Pascal, Defaye;

Failure of a spliced DF-4 ICD lead

Abstract

A 52-year-old man with Brugada syndrome underwent single-chamber implantable cardioveter-defibrillator (ICD) implantation (Medtronic Sprint Quattro 6947M, Medtronic, Inc, Minneapolis, MN) by using a dual-coil DF-4 ICD lead. He did not engage in any high-risk sports or activities that would predispose him to lead fracture. The ICD generator was implanted subpectorally. No sharp angulation of the lead in the pocket was noted on the postoperative chest X-ray. Seventeen months post-implantation, remote monitoring reported a “red” alert related to a high impedance (43000 Ω) of the right ventricular pace/sense lead and many short R-R interval detections. Lead Integrity Alert was activated, which prevented inappropriate ICD therapies. An urgent clinic visit was arranged and threshold testing showed failure of right ventricular capture even at maximal pacing output. Manipulation of the pocket reproduced oversensing in true bipolar, but not in integrated bipolar sensing. Lead extraction was achieved with manual traction 2 days later. Although the polyurethane insulation surrounding the lead was intact, a conductor fracture could be observed through the insulation just distal to the DF-4 connector (Figure 1). Char inside the insulation at the fracture site was also noted. The postmarketing quality service assessment confirmed that the pace/sense ring conductor was fractured 6 cm from the connector end without insulation breach. This first report of a DF-4 ICD lead fracture highlights its potential early vulnerability. Medtronic Sprint Quattro DF-4 lead has been entirely redesigned, with 3 different splices located in the lead. This may increase the risk of connector failure. Although no conclusions can be drawn from this single report, the risks and benefits of this new connector should be considered carefully before adopting it as a new standard of care. Previous studies of ICD lead failure (involving recall and non-recall leads) have not demonstrated any association between technical or radiographic factors and subsequent lead fracture. 1,2 Although this new

Related Organizations
Keywords

Male, Electrocardiography, Humans, Equipment Failure, Middle Aged, Device Removal, Brugada Syndrome, Defibrillators, Implantable, Follow-Up Studies

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
5
Average
Top 10%
Average
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